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OBJECTIVES: Emergency medical triage is crucial for prioritizing patient care in emergency situations, yet its effectiveness can vary significantly based on the experience and training of the personnel involved. This study aims to evaluate the efficacy of integrating Retrieval Augmented Generation (RAG) with Large Language Models (LLMs), specifically OpenAI's GPT models, to standardize triage procedures and reduce variability in emergency care. METHODS: We created 100 simulated triage scenarios based on modified cases from the Japanese National Examination for Emergency Medical Technicians. These scenarios were processed by the RAG-enhanced LLMs, and the models were given patient vital signs, symptoms, and observations from emergency medical services (EMS) teams as inputs. The primary outcome was the accuracy of triage classifications, which was used to compare the performance of the RAG-enhanced LLMs with that of emergency medical technicians and emergency physicians. Secondary outcomes included the rates of under-triage and over-triage. RESULTS: The Generative Pre-trained Transformer 3.5 (GPT-3.5) with RAG model achieved a correct triage rate of 70%, significantly outperforming Emergency Medical Technicians (EMTs) with 35% and 38% correct rates, and emergency physicians with 50% and 47% correct rates (p < 0.05). Additionally, this model demonstrated a substantial reduction in under-triage rates to 8%, compared with 33% for GPT-3.5 without RAG, and 39% for GPT-4 without RAG. CONCLUSIONS: The integration of RAG with LLMs shows promise in improving the accuracy and consistency of medical assessments in emergency settings. Further validation in diverse medical settings with broader datasets is necessary to confirm the effectiveness and adaptability of these technologies in live environments.
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Various types of small-scale wastewater treatment systems are widely used in rural areas, and life-cycle assessment (LCA) should be performed to evaluate their environmental performance. In this study, septic systems were first classified into five categories based on their wastewater treatment performance. Effluent samples from actual systems were collected, and their water qualities were determined. A model to evaluate the environmental load from the septic systems using LCA methods was then established. The water-quality values obtained were input to the model, and the life-cycle environmental costs of the classified septic systems were calculated. The mean environmental load of the effluent during the operation stage was 37.6%, confirming that evaluation of an effluent discharge inventory using LCA, inspection, and water-quality monitoring to improve operations is critical for reducing the environmental load. The operation stage accounts for over 99% of the involved eutrophication, biological toxicity, and toxic chemicals, which are strongly related to the quality of the effluent. Evaluation of the effluent discharge inventory using LCA is of great significance, even for small-scale wastewater treatment systems. The set of procedures developed in this study can be used to calculate comprehensive environmental impacts at wastewater treatment plants.
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Eliminação de Resíduos Líquidos , Águas Residuárias , Eliminação de Resíduos Líquidos/métodos , Água , Japão , Meio AmbienteRESUMO
Sodium niobate (NaNbO3) is a potential material for lead-free dielectric ceramic capacitors for energy storage applications because of its antipolar ordering. In principle, a reversible phase transition between antiferroelectric (AFE) and ferroelectric (FE) phases can be induced by an application of electric field (E) and provides a large recoverable energy density. However, an irreversible phase transition from the AFE to the FE phase usually takes place and an AFE-derived polarization feature, a double polarization (P)-E hysteresis loop, does not appear. In this study, we investigate the impact of chemically induced hydrostatic pressure (pchem) on the phase stability and polarization characteristics of NaNbO3-based ceramics. We reveal that the cell volume of Ca-modified NaNbO3 [(CaxNa1-2xVx)NbO3], where V is A-site vacancy, decreases with increasing x by a positive pchem. Structural analysis using micro-X-ray diffraction measurements shows that a reversible AFE-FE phase transition leads to a double P-E hysteresis loop for the sample with x = 0.10. DFT calculations support that a positive pchem stabilizes the AFE phase even after the electrical poling and provides the reversible phase transition. Our study demonstrates that an application of positive pchem is effective in delivering the double P-E loop in the NaNbO3 system for energy storage applications.
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We investigate the origin of ferroelectricity in the BiFeO3-LaFeO3 system in rhombohedral R3c and tetragonal P4mm symmetries by ab initio density functional theory calculations and compare their electronic features with paraelectric orthorhombic Pnma symmetry. We show that a coherent accommodation of stereo-active lone pair electrons of Bi is the detrimental factor of ferroelectricity. A Bloch function arising from an indirect Bi_6p-Fe_3d hybridization mediated through O_2p is the primary origin of spontaneous polarization (Ps) in the rhombohedral system. In the orthorhombic system, a similar Bloch function was found, whereas a staggered accommodation of stereo-active lone pair electrons of Bi exclusively results in paraelectricity. A giant Ps reported in the tetragonal system originates from an orbital hybridization of Bi_6p and O_2p, where Fe-3d plays a minor role. The Ps in the rhombohedral system decreases with increasing La content, while that in the tetragonal system displays a discontinuous drop at a certain La content. We discuss the electronic factors affecting the Ps evolutions with La content.
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We performed whole genome sequence analyses of Agreia sp. D1110 and Microbacterium trichothecenolyticum D2006 that secrete enzymes to produce cyclo-{â6)-α-d-Glcp-(1â6)-α-d-Glcp-(1â6)-α-d-Glcp-(1â6)-α-d-Glcp-(1â} (CI4) from dextran. Full-length amino acid sequences of CI4-forming enzymes were identified by matching known N-terminal amino acid sequences with products of the draft genome. Domain searches revealed that the CI4-forming enzymes are composed of Glycoside Hydrolase family 66 (GH66) domain, Carbohydrate Binding Module family 35 (CBM35) domain, and CBM13 domain, categorizing the CI4-forming enzymes in the GH66. Furthermore, the amino acid sequences of the two CI4-forming enzymes were 71% similar to each other and up to 51% similar to cycloisomaltooligosaccharide glucanotransferases (CITases) categorized in GH66. Differences in sequence between the CI4-forming enzymes and the CITases suggest mechanisms to produce specific cycloisomaltooligosaccharides, and whole genome sequence analyses identified a gene cluster whose gene products likely work in concert with the CI4-forming enzymes.
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MicrobacteriumRESUMO
Superlattice-structured epitaxial thin films composed of Mn(5%)-doped BiFeO3 and BaTiO3 with a total thickness of 600 perovskite (ABO3) unit cells were grown on single-crystal SrTiO3 substrates by pulsed laser deposition, and their polarization and dielectric properties were investigated. When the layers of Mn-BiFeO3 and BaTiO3 have over 25 ABO3 unit cells (N), the superlattice can be regarded as a simple series connection of their individual capacitors. The superlattices with an N of 5 or less behave as a unified ferroelectric, where the BaTiO3 and Mn-BiFeO3 layers are structurally and electronically coupled. Density functional theory calculations can explain the behavior of spontaneous polarization for the superlattices in this thin regime. We propose that a superlattice formation comprising two types of perovskite layers with different crystal symmetries opens a path to novel ferroelectrics that cannot be obtained in a solid solution system.
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This study aimed to perform a comparative analysis of postoperative results between lumbar degenerative spondylolisthesis (LDS) treated with oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) from the Chiba spine surgery registry database. Sixty-five patients who underwent single-level OLIF (O group) for LDS with ≥ 3 years' follow-up were retrospectively reviewed. The control group comprised 78 patients who underwent single-level TLIF (T group). The analyzed variables included global alignment, radiological parameters of fused segments, asymptomatic and symptomatic ASD incidence, clinical outcomes at 3 years postoperatively using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire data, visual analogue scale scores for low back pain, lower extremity pain, and lower extremity numbness. There was no significant change in global alignment between the two groups. The rate of improvement in anterior intervertebral disc height was not significantly different between the groups at 1-month postoperatively. However, at the final evaluation, the anterior intervertebral disc height and incidence of asymptomatic ASD were significantly higher in the O group. There was no significant difference in symptomatic ASD, reoperation cases, or clinical results between groups. Thus, single-level OLIF can maintain the corrected disc height, but as it has no effect on global alignment, its benefit is limited.
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Vértebras Lombares/cirurgia , Espondilolistese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
Cultivated strawberry is the most widely consumed fruit crop in the world, and therefore, many breeding programs are underway to improve its agronomic traits such as fruit quality. Strawberry cultivars were vegetatively propagated through runners and carried a high risk of infection with viruses and insects. To solve this problem, the development of F1 hybrid seeds has been proposed as an alternative breeding strategy in strawberry. In this study, we conducted a potential assessment of genomic selection (GS) in strawberry F1 hybrid breeding. A total of 105 inbred lines were developed as candidate parents of strawberry F1 hybrids. In addition, 275 parental combinations were randomly selected from the 105 inbred lines and crossed to develop test F1 hybrids for GS model training. These populations were phenotyped for petiole length, leaf area, Brix, fruit hardness, and pericarp color. Whole-genome shotgun sequencing of the 105 inbred lines detected 20,811 single nucleotide polymorphism sites that were provided for subsequent GS analyses. In a GS model construction, inclusion of dominant effects showed a slight advantage in GS accuracy. In the across population prediction analysis, GS models using the inbred lines showed predictability for the test F1 hybrids and vice versa, except for Brix. Finally, the GS models were used for phenotype prediction of 5,460 possible F1 hybrids from 105 inbred lines to select F1 hybrids with high fruit hardness or high pericarp color. These F1 hybrids were developed and phenotyped to evaluate the efficacy of the GS. As expected, F1 hybrids that were predicted to have high fruit hardness or high pericarp color expressed higher observed phenotypic values than the F1 hybrids that were selected for other objectives. Through the analyses in this study, we demonstrated that GS can be applied for strawberry F1 hybrid breeding.
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The determination of local atomic structure at nanoscale for inhomogeneous systems is challenging. The local arrangement of atoms needs to be studied to understand the local or short-range order structures for disordered materials with a lack of long-range order periodicity. Pair distribution function (PDF) analysis is a technique, that is used to study the short-range order structure of materials: this technique is based on the evaluation of local atomic arrangement using synchrotron and neutron sources. An attempt was made to determine the local arrangement at 20 nm-scale for a typical relaxor ferroelectric material, Pb(Mg1/3Nb2/3)O3(PMN). The PDF technique was employed owing to the limited structural coherence in this disordered material. It was determined that there are three types of structures depending on the distance. A glass-like network structure was observed as a short-range order structure owing to the large off-center shift of lead atoms. With an increase in distance, the structure of PMN changed from rhombohedral to cubic. Using the above-mentioned approach, we elucidated the process of local structure averaging.
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Titanium oxide materials have multiple functions such as photocatalytic and photovoltaic effects. Ferroelectrics provide access to light energy conversion that delivers above-bandgap voltages arising from spatial inversion symmetry breaking, whereas their wide bandgap leads to poor absorption of visible light. Bandgap narrowing offers a potential solution, but this material modification suppresses spontaneous polarization and, hence, sacrifices photovoltages. Here, we report successive-redox mediated ferrophotovoltaics that exhibit a robust visible-light response. Our single-crystal experiments and ab initio calculations, along with photo-luminescence analysis, demonstrate that divalent Fe2+ and trivalent Fe3+ coexisted in a prototypical ferroelectric barium titanate BaTiO3 introduce donor and acceptor levels, respectively, and that two sequential Fe3+/Fe2+ redox reactions enhance the photogenerated power not only under visible light but also at photon energies greater than the bandgap. Our approach opens a promising route to the visible-light activation of photovoltaics and, potentially, of photocatalysts.
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We report the robust ferroelectric properties of (1 - x)(Bi1/2Na1/2)TiO3-x(Bi1/2K1/2)TiO3 (x = 33%) single crystals grown by a top-seeded solution growth process under a high oxygen-pressure (0.9 MPa) atmosphere. The sample exhibit a large remanent polarization of 48 µC/cm2 and a sizeable piezoelectric strain constant of 460 pm/V. Neutron powder diffraction structural analysis combined with first-principles calculations reveals that the large ferroelectric polarization comparable to PbTiO3 stems from the hybridization between Bi-6p and O-2p orbitals at a moderately negative chemical pressure.
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Development of bio-microactuators combining microdevices and cellular mechanical functions has been an active research field owing to their desirable properties including high mechanical integrity and biocompatibility. Although various types of devices were reported, the use of as-is natural muscle tissue should be more effective. An earthworm muscle-driven valve has been created. Long-time (more than 2 min) and repeatable displacement was observed by chemical (acetylcholine) stimulation. The generated force of the muscle (1 cm × 3 cm) was 1.57 mN on average for 2 min by the acetylcholine solution (100 mM) stimulation. We demonstrated an on-chip valve that stopped the constant pressure flow by the muscle contraction. For electrical control, short pulse stimulation was used for the continuous and repeatable muscle contraction. The response time was 3 s, and the pressure resistance was 3.0 kPa. Chemical stimulation was then used for continuous muscle contraction. The response time was 42 s, and the pressure resistance was 1.5 kPa. The ON (closed) state was kept for at least 2 min. An on-chip valve was demonstrated that stopped the constant pressure flow by the muscle contraction. This is the first demonstration of the muscle-based valve that is 100% chemically actuated and controlled.
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Acetilcolina/química , Estimulação Elétrica , Oligoquetos/fisiologia , Animais , Eletricidade , Fenômenos Mecânicos/efeitos da radiação , Contração Muscular/efeitos dos fármacos , Contração Muscular/efeitos da radiação , Músculo Liso/química , Músculos/química , Oligoquetos/química , Traqueia/química , Traqueia/efeitos dos fármacosRESUMO
Controlling and manipulating defects in materials provides an extra degree of freedom not only for enhancing physical properties but also for introducing additional functionalities. In ferroelectric oxides, an accumulation of point defects at specific boundaries often deteriorates a polarization-switching capability, but on the one hand, delivers interface-driven phenomena. At present, it remains challenging to control oxygen vacancies at will to achieve a desirable defect structure. Here, we report a practical route to designing oxygen-vacancy distributions by exploiting the interaction with transition-metal dopants. Our thin-film experiments combined with ab-initio theoretical calculations for BiFeO3 demonstrate that isovalent dopants such as Mn3+ with a partly or fully electron-occupied eg state can trap oxygen vacancies, leading to a robust polarization switching. Our approach to controlling oxygen vacancy distributions by harnessing the vacancy-trapping capability of isovalent transition-metal cations will realize the full potential of switchable polarization in ferroelectric perovskite oxides.
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Spontaneous polarization (Ps) in ferroelectrics has provided the impetus to develop piezoelectric devices such as sensors, actuators and diagnostic imaging transducers. Widely used lead-based perovskites exhibit a composition-driven phase diagram involving a transition region, known as a morphotropic phase boundary, where the ferroelectric structure changes dramatically and the piezoelectric activity is maximal. In some perovskites, ferroic polarization coexists with nonpolar rotations of octahedra, suggesting an unprecedented phase diagram. Here, we show morphotropic phase boundaries, where 'ferrielectric' appears as a bridging phase between ferroelectrics with rhombohedral and tetragonal symmetries in Bi1/2Na1/2TiO3-based perovskites. Neutron diffraction analysis demonstrates that the intermediate ferrielectric displays a small Ps resulting from up and down polarizations coupled with an in-phase TiO6 rotation. Our ab initio calculations indicate that a staggered Bi-O conformation at an appropriate chemical pressure delivers the ferrielectric-mediated phase boundaries, which provides a promising platform for (multi)ferroic materials with enhanced physical properties.
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BACKGROUND: Genetic tools including constitutive and inducible promoters have been developed over the last few decades for strain engineering in Streptomyces. Inducible promoters are useful for controlling gene expression, however only a limited number are applicable to Streptomyces. The aim of this study is to develop a controllable protein expression system based on an inducible promoter using sugar inducer, which has not yet been widely applied in Streptomyces. RESULTS: To determine a candidate promoter, inducible protein expression was first examined in Streptomyces avermitilis MA-4680 using various carbon sources. Xylose isomerase (xylA) promoter derived from xylose (xyl) operon was selected due to strong expression of xylose isomerase (XylA) in the presence of D-xylose. Next, a xylose-inducible protein expression system was constructed by investigating heterologous protein expression (chitobiase as a model protein) driven by the xylA promoter in Streptomyces lividans. Chitobiase activity was detected at high levels in S. lividans strain harboring an expression vector with xylA promoter (pXC), under both xylose-induced and non-induced conditions. Thus, S. avermitilis xylR gene, which encodes a putative repressor of xyl operon, was introduced into constructed vectors in order to control protein expression by D-xylose. Among strains constructed in the study, XCPR strain harboring pXCPR vector exhibited strict regulation of protein expression. Chitobiase activity in the XCPR strain was observed to be 24 times higher under xylose-induced conditions than that under non-induced conditions. CONCLUSION: In this study, a strictly regulated protein expression system was developed based on a xylose-induced system. As far as we could ascertain, this is the first report of engineered inducible protein expression in Streptomyces by means of a xylose-induced system. This system might be applicable for controllable expression of toxic products or in the field of synthetic biology using Streptomyces strains.
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Engenharia Metabólica/métodos , Streptomyces/genética , Acetilglucosaminidase/biossíntese , Aldose-Cetose Isomerases/genética , Regulação Bacteriana da Expressão Gênica , Regiões Promotoras Genéticas , Streptomyces/metabolismoRESUMO
Japanese encephalitis (JE) is an acute viral disease caused by the Japanese encephalitis virus (JEV). JEV strains are classified into 5 genotypes (I-V). JEV genotype V strains have never been detected in Japan to date, but they were recently detected in South Korea. In the present analysis, we tried to determine if a JEV genotype V strain caused any JE case in Japan in 2016. Serum and cerebrospinal fluid samples were collected from 10 JE patients reported in Japan in 2016. JEV RNA was not detected in any of the samples. Although JEV is a single-serotype virus, it can be expected that the neutralizing antibody titers against JEV genotype V strains are higher than those against genotype I and III strains in the serum of patients with JE in Japan whose causative JEV was the genotype V strain. The neutralizing antibody titers against the JEV genotype V strain were not higher than those against the genotype I or III strain in any serum samples. Therefore, the evidence that the JEV genotype V strain caused any JE case in Japan in 2016 was absent.
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Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Vírus da Encefalite Japonesa (Espécie)/classificação , Vírus da Encefalite Japonesa (Espécie)/imunologia , Encefalite Japonesa/imunologia , Genótipo , Adulto , Idoso , Idoso de 80 Anos ou mais , Vírus da Encefalite Japonesa (Espécie)/genética , Feminino , Humanos , Japão , Masculino , Testes de Neutralização , RNA Viral/líquido cefalorraquidianoRESUMO
The paralogous transcription factors AraR and XlnR in Aspergillus regulate genes that are involved in degradation of cellulose and hemicellulose and catabolism of pentose. AraR and XlnR target the same genes for pentose catabolism but target different genes encoding enzymes for polysaccharide degradation. To uncover the relationship between these paralogous transcription factors, we examined their contribution to regulation of the PCP genes and compared their preferred recognition sequences. Both AraR and XlnR are involved in induction of all the pentose catabolic genes in A. oryzae except larA encoding L-arabinose reductase, which was regulated by AraR but not by XlnR. DNA-binding studies revealed that the recognition sequences of AraR and XlnR also differ only slightly; AraR prefers CGGDTAAW, while XlnR prefers CGGNTAAW. All the pentose catabolic genes possess at least one recognition site to which both AraR and XlnR can bind. Cooperative binding by the factors was not observed. Instead, they competed to bind to the shared sites. XlnR bound to the recognition sites mentioned above as a monomer, but bound to the sequence TTAGSCTAA on the xylanase promoters as a dimer. Consequently, AraR and XlnR have significantly similar, but not the same, DNA-binding properties. Such a slight difference in these paralogous transcription factors may lead to complex outputs in enzyme production depending on the concentrations of coexisting inducer molecules in the natural environment.
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Aspergillus oryzae/metabolismo , Proteínas Fúngicas/metabolismo , Regulação Fúngica da Expressão Gênica/fisiologia , Via de Pentose Fosfato/fisiologia , Multimerização Proteica/fisiologia , Elementos de Resposta , Transativadores/metabolismo , Aspergillus oryzae/química , Aspergillus oryzae/genética , Proteínas Fúngicas/química , Proteínas Fúngicas/genética , Transativadores/química , Transativadores/genéticaRESUMO
Photoferroelectrics offer unique opportunities to explore light energy conversion based on their polarization-driven carrier separation and above-bandgap voltages. The problem associated with the wide bandgap of ferroelectric oxides, i.e., the vanishingly small photoresponse under visible light, has been overcome partly by bandgap tuning, but the narrowing of the bandgap is, in principle, accompanied by a substantial loss of ferroelectric polarization. In this article, we report an approach, 'gap-state' engineering, to produce photoferroelectrics, in which defect states within the bandgap act as a scaffold for photogeneration. Our first-principles calculations and single-domain thin-film experiments of BiFeO3 demonstrate that gap states half-filled with electrons can enhance not only photocurrents but also photovoltages over a broad photon-energy range that is different from intermediate bands in present semiconductor-based solar cells. Our approach opens a promising route to the material design of visible-light-active ferroelectrics without sacrificing spontaneous polarization.Overcoming the optical transparency of wide bandgap of ferroelectric oxides by narrowing its bandgap tends to result in a loss of polarization. By utilizing defect states within the bandgap, Matsuo et al. report visible-light-active ferroelectrics without sacrificing polarization.
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Because the functions of polar materials are governed primarily by their polarization response to external stimuli, the majority of studies have focused on controlling polar lattice distortions. In some perovskite oxides, polar distortions coexist with nonpolar tilts and rotations of oxygen octahedra. The interplay between nonpolar and polar instabilities appears to play a crucial role, raising the question of how to design materials by exploiting their coupling. Here, we introduce the concept of 'polarization twist', which offers enhanced control over piezoelectric responses in polar materials. Our experimental and theoretical studies provide direct evidence that a ferrielectric perovskite exhibits a large piezoelectric response because of extended polar distortion, accompanied by nonpolar octahedral rotations, as if twisted polarization relaxes under electric fields. The concept underlying the polarization twist opens new possibilities for developing alternative materials in bulk and thin-film forms.